8th Advances Against Aspergillosis international conference Welcome to the 8th Advances Against Aspergillosis international conference

Introduction and summary of global disease burden David W. Denning National Aspergillosis Centre Wythenshawe Hospital The University of Manchester Global Action Fund for Fungal Infections

2004 (San Francisco) 2006 (Athens) 2008 (Miami) 2010 (Rome) 2012 (Istanbul) 2014 (Madrid) 2016 (Manchester) With over 300 attendees at each meeting

245 papers have been published in 8 Supplements, comprising 1,863 pages of full papers, 1,223 abstracts from the meetings

Welcome to the Mucormycosis community

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Deaths from fungal infections need to fall TB (2015) Malaria (2015) >1,660,000 1,800,000 (200,000 with HIV) 429,000 www.GAFFI.org

Risk groups and frequencies of invasive aspergillosis – different test performances + Severe influenza – 16% + Lung cancer – 2.6% Herbrecht, Ann NY Acad Sci 2012;1271:23

COPD admissions (rate per 40+ years old) Rate of COPD hospitalisation = ~25 – 375/100,000 annually OECD Health Statistics 2013, ttp://dx.doi.org/10.1787/health-data-en. www.GAFFI.org

Xu H et al. Clin Microbiol Infect 2012;18:403. IA in COPD 58 of the 298 COPD admissions with a lower respiratory tract sample processed grew Aspergillus spp. 39 (3.9%) had probable IA. Only 13% had oral corticosteroids 43% died Xu H et al. Clin Microbiol Infect 2012;18:403. www.GAFFI.org

COPD in China 32,800,000 patients with COPD 11,858,100 admissions to hospital 154,155 IA cases in COPD at a 1.3% rate (Spain) 462,466 IA cases in COPD at a 3.9% rate (China) 199,000 deaths predicted annually in China Zhu et al. ECCMID 2013; Abstr 3393. Guinea et al Clin Microbiol Infect 2010;16:870 Xu et al, Clin Microbiol Infect 2012;18:403 www.GAFFI.org

Lung cancer 1,824,700 patients with lung cancer each year If 2.6% develop IA, then: 47,500 cases predicted annually www.Globocan.org Yan X et al, Cancer 2009; 115: 5018 www.GAFFI.org

Invasive aspergillosis complicating cancer and leukaemia www.GAFFI.org

Prognosis of chronic pulmonary aspergillosis 387 cases Mean age 59 years 42 cases Mean age 72 years Lowes et al, Eur Resp J 2017 49: 1601062 Ohba et al. Resp Med 2012;106:724. www.GAFFI.org

Fungal disease of the lungs in outside the hospital ~200 million adult asthmatics www.GAFFI.org

Form of aspergillosis Number Deaths IA 400,000 300,000 CPA 3,000,000 450,000 ABPA 4,800,000 10,000 SAFS 6,500,000 250,000 Total 14,700,000 1,010,000

5 aspirational targets for aspergillosis to be achieved by 2030

Aspergillosis Target 1: Survival in invasive aspergillosis increased to 90% (up from under 50%)

Aspergillosis Target 2: Plugging the major gaps in our understanding of the biological, immunological and genetic basis of aspergillosis

Aspergillosis Target 3: New simple screening tests developed Diagnostics (most countries, including all of Africa, have no diagnostic capability at all) New widely available, standardized and clinically validated diagnostics techniques New simple screening tests developed

Aspergillosis Target 4: (only 3 classes currently available) Treatment New antifungal agents licensed for invasive, chronic and allergic aspergillosis and for all age groups (only 3 classes currently available)

Aspergillosis Target 5: At least one vaccine against aspergillosis in clinical trials or approved (none currently)

Other needs: Improvement in the public’s awareness of fungal diseases and specifically aspergillosis Keeping homes free from excessive Aspergillus and other moulds related to dampness, which increases the number and severity of asthma episodes Stronger evidence base of antifungal therapy allergic aspergillosis to reduce the number and severity of asthma episodes, and probably asthma deaths Hospital environments for vulnerable patients free of Aspergillus Reduction in azole resistance with reduced use of azole fungicides in non-essential crops Prevention of a new epidemic of resistance with any new classes of antifungal used for aspergillosis by not allowing such chemical class to be used as a fungicide Need for better surveillance and detailed epidemiology data Development of immunotherapies as well as vaccines

Many thanks to all our sponsors You have made the meeting possible

Enjoy the conference Please be at your poster on your odd or even day, as the SAGE squads will be visiting